Lack of Association between Recurrent Pregnancy Loss and Inherited Thrombophilia in a Group of Colombian Patients

Factor V Leiden 1691G > A mutation and the risk of recurrent pregnancy loss (RPL): systematic review and meta-analysis

Background

Although numerous replication case-control studies have attempted to determine the association between Factor V Leiden (FVL) 1691G > A mutation and susceptibility to Recurrent pregnancy loss (RPL), there have been confliction among the results of various ethnic groups. To address this limitation, here we implemented first meta-analysis to provide with consistent conclusion of the association between FVL 1691G > A mutation and RPL risk.

Methods

After a systematic literature search, pooled odds ratio (OR) and their corresponding 95% confidence interval (CI) were used to evaluate the strength of the association. Additionally, meta-regression analyses were performed to find potential source of heterogeneity.

Results

In this meta-analysis, 62 studies, containing 10,410 cases and 9406 controls, were included in quantitative analysis. Overall population analysis revealed a significant positive association in the dominant (OR = 2.15, 95% CI = 1.84-2.50, P < 0.001), over-dominant (OR = 1.88, 95% CI = 1.61-2.19, P < 0.001), allelic (OR = 2.05, 95% CI = 1.79-2.35, P < 0.001), and heterozygote (OR = 1.97, 95% CI = 1.68-2.30, P < 0.001) models. Moreover, a significant association of dominant (OR = 3.04, 95% CI = 2.04-4.54, P < 0.001), over-dominant (OR = 2.65, 95% CI = 1.74-4.05, P < 0.001), and heterozygote (OR = 2.67, 95% CI = 1.81-4.22, P < 0.001) models was found in the Iranian population. The subgroup analysis indicated strong significant association in Asian, European, Africa population, and case-control studies but not in South Americans and cohort studies.

Conclusion

The FVL 1691G > A mutation and the risk of RPL confers a genetic contributing factor in increasing the risk of RPL, particularly in Iranians, except for South Americans.

Recurrent pregnancy loss: can factor V Leiden mutations be a cause

The role of Factor V Leiden (FVL) mutation in recurrent miscarriages has been disputed. It has been hypothesized that FVL mutation in patients with recurrent miscarriages is treatable. In this study, we evaluated 78 pregnant women for FVL mutations, among whom 50 had a history of recurrent miscarriages. Only 1 (2%) of the woman was positive for heterozygous FVL mutation. The incidence of FVL mutations in patients with recurrent pregnancy loss had an odds ratio of 1.72 (95% confidence interval, 0.0681–43.8257; P>0.05). However, the findings were not statistically significant. Thus, we suggest that FVL mutation study may not be included in the battery of tests for recurrent miscarriages in the Indian population.

Association of parental methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism in couples with unexplained recurrent pregnancy loss

Objective

The aim of this study was to identify the association of parental MTHFR C677T gene polymorphism in couples with and without RPL history.

Results

During the study, 21.4% (15/70) of Ala222Val polymorphism was observed among RPL couples while no polymorphism was seen among normal, healthy couples. Our study did not find any association between MTHFR C677T polymorphism and gender (p > 0.05), gestational period (p > 0.05), geographical region (p > 0.05) and menstrual history (p > 0.05). However, significant association was seen between MTHFR C677T polymorphism and number of losses (p < 0.05), concluding that the risk of the polymorphism increased with the increase in number of losses. Significant variation in the MTHFR C677T genotype with number of losses among RPL couples were seen but not with other study variables.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3321-x) contains supplementary material, which is available to authorized users.

Prevalence and role of antithrombin III, protein C and protein S deficiencies and activated protein C resistance in Kosovo women with recurrent pregnancy loss during the first trimester of pregnancy

CONTEXT

Several studies have reported that thrombophilia is responsible for recurrent pregnancy loss (RPL).

AIMS

The aim of this study was to evaluate the prevalence and role of inherited thrombophilia in early pregnancy loss, specifically in the first trimester.

MATERIALS AND METHODS

A total of 104 women (patients) with a history of two or more miscarriages during the first trimester of pregnancy and 110 women (controls) who had experienced two or more births without a miscarriage were included in this study. In both groups, we determined the biological activities of antithrombin III (ATIII) and protein C (PC) using the chromogenic method and the biological activity of protein S (PS) and the activated protein C resistance (APCR) were examined using a clotting method.

RESULTS

In the patient group, deficiencies of ATIII, PC, and PS were detected in 3 (2.88%), 4 (3.85%), and 6 (5.77%) cases, respectively. In the control group, ATIII (0%) deficiencies were not detected, and deficiencies for PC (0.9%) and PS (0.9%) were each detected in 1 patient. APCR was detected in 9 patients (8.65%) and 4 control subjects (3.63%).

CONCLUSION

Based on our results, we can conclude that thrombophilia is a causal factor for miscarriages in the first trimester of pregnancy, although there are the conflicting data in the literature.

Frequency of hereditary thrombophilia in women with recurrent pregnancy loss in Northern Pakistan

AIM

Hereditary thrombophilia (HT) screening is performed as routine work-up of recurrent pregnancy loss (RPL) in Pakistan. In Northern Pakistan the prevalence of HT is not known. HT is not detected in the majority of RPL cases, especially in patients with ≤ 3 pregnancy losses (PL). The aim of this study was to determine the frequency of HT in women with RPL, and to find the prevalence of HT in patients with ≤ 3 PL and > 3 PL.

MATERIAL AND METHODS

Lupus-anticoagulant-negative patients with unexplained RPL were screened for protein C, protein S, antithrombin, and factor V Leiden.

RESULTS

A total of 315 patients with RPL were screened and 13 (4%) had evidence of HT. Protein C and protein S deficiency were detected in 6/140 (4.3%) women with > 3 PL and in 2/175 (1.1%) women with ≤ 3 PL. Antithrombin deficiency was detected in 2/140 (0.75%) women with > 3 PL and in no patients with ≤ 3 PL. Factor V Leiden was detected in 3/26 (12%) women with > 3 PL and in no patients with ≤ 3 PL. The prevalence of HT in patients with >3 PL was significantly higher than in patients with ≤ 3 PL (P = 0.002). We detected a strong association between HT and >3 PL (odds ratio 7.3; 95% confidence interval: 1.60-33.85) as compared to ≤ 3 PL.

CONCLUSION

HT was detected in 4% of patients with RPL. The prevalence of HT in patients with > 3 PL is significantly higher than in patients with ≤ 3 PL.

Activated protein C resistance and antiphospholipid antibodies in recurrent fetal loss: experience of a single referral center in northern iraq

The current study was initiated to determine the prevalence of activated protein C (APC) resistance, factor V Leiden and antiphospholipid antibodies (APA) in Iraqi women with recurrent fetal loss (RFL), and evaluate the outcome of intervention in those with such states. For this purpose a total of 103 Iraqi women referred to a major teaching hospital in Northern Iraq with two or more consecutive fetal losses, as well as 100 age matched women with no history of fetal loss and at least one live birth were enrolled. After appropriate clinical evaluation, the enrolled subjects were tested for APA as well as APC resistance. Subjects who were APC resistant were further tested for factor V Leiden mutation using a polymerase chain reaction and reverse hybridization. Patients with documented APA and/or with APC resistance, were put on low dose aspirin with or without low molecular weight heparin during pregnancy, and followed for a minimum of 5 years. The results revealed that among patients' group, APA were detected in 19.4 % compared to 1.0 % of the controls (OR 23.9, p = 0.00005). On the other hand, APC resistance was documented in 9.7 % compared to 1.0 % of the controls (OR 10.6, p = 0.01). Factor V Leiden was detected in 3.9 % of patients and 1 % of the controls (p = 0.38). Among 17 patients with APA available for follow up, there were 24 pregnancies, 18 of which ended with live births (75 %). While among the ten patients who had factor V Leiden or were APC resistant non-carriers, there were 13 pregnancies, 12 ended with live births (92.3 %). In conclusion, this study has demonstrated that among the enrolled Iraqi women, APA and APCR and not factor V Leiden were significantly associated with RFL, and that treatment with aspirin (with or without low molecular weight heparin) had lead to live births in 80.6 % of pregnancies.